title: Can milnacipran used for neuropathic pain in patients with advanced cancer cause neuromuscular and somatosensory disorders?
abstract: BACKGROUND
  Milnacipran is one of the classes of drugs that are serotonin and norepinephrine reuptake inhibitors (SNRIs). It is a promising drug for the treatment of neuropathic pain in patients with advanced cancer. However, we found that neuromuscular and somatosensory disorders occurred when milnacipran was used as an adjuvant analgesic.
  
  
  METHODS
  A 66-year-old woman with a history of neuropathic pain was given 15 mg of milnacipran after dinner. The next morning she developed stiffness of the fingers, numbness in the mandible, and the soles of her feet felt swollen. Milnacipran was discontinued and her symptoms disappeared immediately. We managed this case, which was becoming severe, by discontinuing milnacipran on early detection of symptoms.
  
  
  CONCLUSIONS
  This is the first report that demonstrates an adverse reaction of milnacipran when used as an analgesic adjuvant, and not as an antidepressant drug, for neuropathic pain in patients with advanced cancer. The analgesic effect of SNRIs will likely be used in the management of neuropathic pain in the future; however, clinicians should be aware of the early adverse reactions to these agents.
authors.affiliation: Department of Hospital Pharmacy Education, Graduate School of Pharmaceutical Science, Osaka University, Osaka, Japan. nakagawa@pharm.kobegakuin.ac.jp
authors.forename: Sari
authors.initials: S
authors.lastname: Nakagawa
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Satoru
authors.initials: S
authors.lastname: Tsuneto
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tanimukai
authors.forename: Sho
authors.initials: S
authors.lastname: Goya
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Oono
authors.forename: Mamiko
authors.initials: M
authors.lastname: Tsugane
authors.forename: Etsuko
authors.initials: E
authors.lastname: Uejima
mesh_terms: D000368:Aged; D000075202:Contraindications; D003521:Cyclopropanes / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000078764:Milnacipran; D009367:Neoplasm Staging; D009369:Neoplasms / Q000503:physiopathology*; D009437:Neuralgia / Q000188:drug therapy*; D009468:Neuromuscular Diseases / Q000139:chemically induced*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D020886:Somatosensory Disorders / Q000139:chemically induced*; D016896:Treatment Outcome
chemical_list: D003521:Cyclopropanes; D000078764:Milnacipran; D017367:Selective Serotonin Reuptake Inhibitors